Prevention, screening, assessing and managing of non-adherent behaviour in people with rheumatic and musculoskeletal diseases: systematic reviews informing the 2020 EULAR points to consider

• DOI: 10.1136/rmdopen-2020-001432on
• Publication Date: 2020-10-01
• Authors: Valentin Ritschl; Tanja Stamm; Daniel Aletaha; J. W. J. Bijlsma; Peter Böhm; Răzvan Drăgoi; Emma Dures; Fernando Estévez‐...; Laure Gossec; Annamaria Iagnocco; José B Negrón; Michal Nudel; Andréa Marques; Ellen Moholt; Conni Skrubbeltrang; Bart J. F. van de...; Kirsten K. Viktil; Marieke Voshaar; Loreto Carmona; Annette de Thurah
• Keywords: Radboudumc 18: Healthcare improvement science RIHS: Radboud Institute for Health Sciences; Patient Care Team; [SDV.MHEP.RSOA] Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system; Epidemiology; EMC OR-01; R; Radboud University Medical Center; Clinical Pharmacy - Radboud University Medical Center; Epidemiology; Health services research; Patient Care Team; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; [SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system; Health services research; Medicine; Humans; Patient Compliance; Musculoskeletal Diseases; Delivery of Health Care; Exercise; Systematic Reviews as Topic

ObjectiveTo analyse how non-adherence to prescribed treatments might be prevented, screened, assessed and managed in people with rheumatic and musculoskeletal diseases (RMDs).MethodsAn overview of systematic reviews (SR) was performed in four bibliographic databases. Research questions focused on: (1) effective interventions or strategies, (2) associated factors, (3) impact of shared decision making and effective communication, (4) practical things to prevent non-adherence, (5) effect of non-adherence on outcome, (6) screening and assessment tools and (7) responsible healthcare providers. The methodological quality of the reviews was assessed using AMSTAR-2. The qualitative synthesis focused on results and on the level of evidence attained from the studies included in the reviews.ResultsAfter reviewing 9908 titles, the overview included 38 SR on medication, 29 on non-pharmacological interventions and 28 on assessment. Content and quality of the included SR was very heterogeneous. The number of factors that may influence adherence exceed 700. Among 53 intervention studies, 54.7% showed a small statistically significant effect on adherence, and all three multicomponent interventions, including different modes of patient education and delivered by a variety of healthcare providers, showed a positive result in adherence to medication. No single assessment provided a comprehensive measure of adherence to either medication or exercise.ConclusionsThe results underscore the complexity of non-adherence, its changing pattern and dependence on multi-level factors, the need to involve all stakeholders in all steps, the absence of a gold standard for screening and the requirement of multi-component interventions to manage it.